Individual
MR. MICHAEL D. VISSING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
3991 DUTCHMANS LN STE 205, LOUISVILLE, KY 40207
(502) 899-6170
(502) 899-6179
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA063
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95000634
—
KY
Enumeration date
07/18/2005
Last updated
10/29/2020
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